机械通气患者能量消耗评估准确性的比较研究

Assessment the accuracy of resting energy expenditure methods between predicted equations and indirect calorimetry in mechanically ventilated patients

目的研究分析机械通气患者能量消耗实测值与常用能量预测公式值之间的一致性。方法对61例机械通气患者进行问接测热法测定其静息能量代谢。并分别用Harris—Benedict公式（简称H—B公式）、FAO／WHO／UNU公式、Mifflin公式计算其能量代谢。用Bland—Ahman法进行实测值与预计值的一致性分析。并比较外科疾病及内科疾病不同病因的能量代谢的差异。结果间接测热法测得的能量消耗与H—B公式比较差异无统计学意义（P〉0．05）；与FAO／WHO／UNU及Mifflin法比较差异有统计学意义（P〈0．05或P〈0．001）。但用Bland—Ahman法分析，虽然3个公式预计值与实测值在95％的平均差值±1．96sd区间内符合率较高，分别达93．4％、95．1％、95．1％，但离散区间较大，在实测值平均值±10％的范围内符合率低（18．3％）。结论采用Bland—Ahman法提示，机械通气患者能量实测值与常用能量预测公式预计值一致性差，建议使用间接测热法测定机械通气患者的能量消耗。

Objective To compare of resting energy expenditure prediction methods with measured resting energy expenditure in mechanically ventilated patients. Methods 61 cases of mechanical ventilation were measured resting energy expenditure （MREE） by metabolic cart and predicted energy expenditure hy Harris - Benedict （ H - B） , FAO/WHO/UNU and Mifflin equations. The limits of agreement were assessed with Bland - Ahman method. And the metabolism levels between medical patients and surgical ones were also compared. Results There was no significant difference between H- B equation and MREE（P 〉0.05 ）, and there was significant difference between the other two equations and MREE（P 〈 O. 05）. However when these values were analyzed by Bland, Ahman method, although the limits of agreement at 95% mean difference ± 1.96Sd were respectiVely 93.4%, 95.1%, 95. 1% between three equations and MREE, the limits of agreement were too wide to be accepted clinically. The limits of agreement at ± 10% of mean measured REE between MREE and equations were only at about 18.3%. Conclusion Bland - Altman method indicates that the limits of agreement between MREE and equations were poor, it may be necessary to measure individual REE using indirect calorimetry in mechanically ventilated patients.